April 2014
Volume 55, Issue 13
Free
ARVO Annual Meeting Abstract  |   April 2014
Refining the ultra-wide field colour fundus photography grading scheme for use in epidemiological studies
Author Affiliations & Notes
  • Nicola Bernadette Quinn
    Centre for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
  • Asma Aslam
    UCL Institute of Ophthalmology, University College London, London, United Kingdom
  • Imre Lengyel
    UCL Institute of Ophthalmology, University College London, London, United Kingdom
  • Tunde Peto
    NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
  • Ruth E Hogg
    Centre for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
  • Footnotes
    Commercial Relationships Nicola Quinn, Optos Plc (F); Asma Aslam, Optos Plc (F); Imre Lengyel, Optos Plc (F); Tunde Peto, Optos Plc (F); Ruth Hogg, Optos Plc (F)
  • Footnotes
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Investigative Ophthalmology & Visual Science April 2014, Vol.55, 4818. doi:
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    • Get Citation

      Nicola Bernadette Quinn, Asma Aslam, Imre Lengyel, Tunde Peto, Ruth E Hogg; Refining the ultra-wide field colour fundus photography grading scheme for use in epidemiological studies. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4818.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract
 
Purpose
 

To develop a grading scheme to classify peripheral retinal lesions suitable for use in a large epidemiological study.

 
Methods
 

A grading scheme was developed based on a combination of the Moorfield’s grid (which is derived from the International Classification for age-related macular degeneration (AMD)) and the Wisconsin age-related maculopathy grading scheme (WARMGS) grid. These macula centred grids were extended with further two zones in order to capture information from the peripheral retina. Both peripheral zones were divided into eight sub-fields. A systematic review of potential retinal lesions identified the following lesions for presence/absence evaluations: choroidal neovascular membrane, geographic atrophy, floaters, naevi, retinal tears, white without pressure and haemorrhages. In this study drusen and RPE changes were evaluated. Validation and inter-grader repeatability was undertaken by two independent graders using images from the Reykjavik Eye Study. Hundred OPTOMAP P200C AF ultra-wide field laser scanning ophthalmoscope colour images of fifty participants were selected randomly from the 12-year follow-up of the Reykjavik Eye Study. Percentage of lesions located in the various zones and segments was calculated to inform on optimal design of a peripheral retinal grid.

 
Results
 

Agreement for identification of peripheral lesions ranged from 60%-100% (Kappa 0.48-1.0). Agreement was highest for presence or absence of individual retinal lesions (97-100%, Kappa 0.92-1.0). Greatest variability was for presence of drusen in the various zones (60%-99%, Kappa 0.47-0.70). Drusen were most frequently located superiorly (68%). RPE changes were also seen most commonly in the superior sub fields (63%), in the most peripheral zones (81%) and in those sub fields closest to the mid-line (75%).

 
Conclusions
 

In developing a grid for grading peripheral lesions, our findings suggest that the area beyond the traditional macula grids should include zones to separate the mid periphery from the far periphery and also include sub-fields that respect the mid-line. Therefore we propose a grid that includes 16 peripheral sub-fields. This grading scheme showed low variability between graders and therefore should prove suitable for use in a large epidemiological studies.

 
Keywords: 552 imaging methods (CT, FA, ICG, MRI, OCT, RTA, SLO, ultrasound) • 688 retina • 465 clinical (human) or epidemiologic studies: systems/equipment/techniques  
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